Rapid sequence intubation
Rapid sequence intubation (Salt Spring Island protocol)
Advanced airway support
An emergency cricothyrotomy requires
A #4 Shiley tracheal tube is an adequate size for the majority of adults
Cricothyrotomy should be considered a blind technique. Success rates are only 70% for inexperienced clinicians.
Creation of a false passage outside the trachea
Injury to structures of the neck
Delayed voice changes and stenosis may occur
Cricothyrotomy is contraindicated in patients younger than 12 years of age because of the small size of the membrane, and needle cricothyrotomy should be used in these patients.
Needle cricothyrotomy utilizes a large-guage needle to access the cricothyroid membrane. Oxygenation can be performed with a BVM, or preferably with jet ventilation.
Jet ventilation should be set at 50 psi for adults and 25 psi for children. Four seconds of expiration is allowed for each second of insufflation.